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BCPS Exam > FEN: Parenteral Nutrition III > Flashcards

FEN: Parenteral Nutrition III Flashcards

1
Q

List five broad categories of PN complications

A
  1. Catheter-related complications
  2. Fluid and electrolyte
  3. Long-term PN complications
  4. Incorrect feeding rate
  5. Incorrect macronutrient formulation
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2
Q

List three catheter-related complications of PN

A
  1. Catheter-related infections
  2. catheter insertion complications
  3. Peripheral venous thrombophlebitis
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3
Q

List two fluid and electrolyte complications of PN

A
  1. Fluid imbalance

2. Acid base imbalance

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4
Q

List four long term complications of PN

A
  1. Aluminum toxicity*
  2. Hepatobiliary disorders
  3. Osteoporosis and osteromalacia
  4. Gut atrophy
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5
Q

List two complications related to incorrect feeding rate

A
  1. Overfeeding

2. Refeeding syndrome

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6
Q

List two complications related to incorrect macronutrient formulation

A
  1. Hyperglycemia

2. Essential fatty acid deficiency

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7
Q

Catheter related infections are caused primarily by what two microorganisms?

A
  1. Staphylococcus aureus

2. Candida albicans

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8
Q

List two types of catheter insertion complications

A
  1. pneumothorax

2. incorrect placement

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9
Q

How to prevent peripheral venous thrombophlebitis from PN?

A

Peripheral venous thrombophlebitis can occur with peripheral catheter placement. Risk is increased by day 4 of catheterization; therefore, site should be rotated every 3 days.

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10
Q

Acid-base imbalances: excessive _____ salts in the PN can cause a metabolic acidosis; whereas excessive _____ salts in the PN can cause a metabolic alkalosis

A
  1. Excessive chloride salts can cause a metabolic acidosis

2. Excessive acetate salts can cause a metabolic alkalosis

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11
Q

Hyperglycemia resulting from PN can lead to ____ and ____ infections

A
  1. Nosocomial infections

2. Wound infections

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12
Q

List four complications of overfeeding

A
  1. Hepatic steatosis
  2. Hypercapnia (e.g. harder to wean from ventilator)
  3. Hyperglycemia
  4. Azotemia
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13
Q

How quickly can essential fatty acid deficiency develop with PN, and what kind of PN is likely to cause it?

A

1-3 weeks of a lipid-free PN

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14
Q

List seven symptoms of essential fatty acid deficiency?

A
  1. skin desquamation
  2. hair loss
  3. impaired wound healing
  4. hepatomegaly
  5. thrombocytopenia
  6. fatty liver
  7. anemia
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15
Q

What are three symptoms that characterize refeeding syndrome?

A
  1. Hypophosphatemia
  2. Hypokalemia
  3. Hypomagnesemia
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16
Q

What are the three late complications of refeeding syndrome?

A
  1. Cardiac dysfunction
  2. Respiratory dysfunction
  3. Death
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17
Q

What are three steps in preventing refeeding syndrome?

A
  1. Identify patients at risk
  2. Start slow
  3. Supplement before initiating PN and monitor
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18
Q

What seven patients are at risk for refeeding syndrome?

A
  1. Anorexia
  2. Alcoholism
  3. Cancer
  4. Chronically ill
  5. Poor nutritional intake for 1-2 weeks
  6. Recent unintentional weight loss
  7. Malabsorption
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19
Q

How to start slow with refeeding syndrome?

A

Initially provide less than 50% of caloric requirements, and advance over several days to desired goal.

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20
Q

How to supplement and monitor to prevent refeeding syndrome?

A
  1. Before initiating PN, supplement vitamins as well as K+, phosphate and magnesium if needed.
  2. Monitor daily for at least 1 week
  3. Replace electrolytes as needed, many patients will need aggressive replacement during first week of PN.
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21
Q

Aluminum toxicity is most likely to occur in what two types of patients?

A
  1. Receiving long-term PN

2. Renal dysfunction

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22
Q

Why is aluminum toxicity more likely to occur in patients with renal dysfunction?

A

Aluminum is eliminated renally

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23
Q

List three complications of aluminum toxicity

A
  1. Osteopenia
  2. Neurotoxicity
  3. Microcytic anemia
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24
Q

How does aluminum toxicity cause osteopenia?

A

Accumulates in bone and interferes with bone Ca2+ uptake

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25
How does aluminum get into the patients body?
Contaminates many IV electrolytes and IV fluids
26
How to find out how much aluminum a patient is receiving due to contamination?
Aluminum content documented on drug labels
27
List three hepatobiliary disorders resulting from PN
1. Steatosis 2. Cholestasis 3. Gallbladder stasis: sludge, stones, cholecystitis
28
What is the typical cause of steatosis from PN?
Overfeeding
29
How does steatosis present in early stages?
Transient elevation in aminotransferase concentrations
30
How does steatosis present in late stages?
Fibrosis or cirrhosis
31
In whom does cholestasis usually appear in from PN?
1. Usually children | 2. Also adults receiving long-term PN
32
What is the primary sign of cholestasis resulting from PN?
Conjugated bilirubinc oncentration greater than 2 mg/dL
33
Why does gallbladder stasis occur in patients receiving PN?
Gall bladder stasis is associated with the development of gallstones, sludge and cholecystitis; it is more attributable to a lack of EN than to PN administration.
34
List two reasons osteoporosis and osteomalacia can develop in patients receiving long-term PN
1. Higher protein doses cause increaased Ca2+ excretion | 2. Chronic metabolic acidosis because of insufficient acetate
35
List six, general monitoring categories for patients receiving PN
1. Infection and phlebitis 2. Fluid and general nutritional status 3. Salts: Electrolyte and acid/base 4. Fats and sugars 5. Liver 6. Readiness to switch
36
List two kinds of monitoring related to infection and phlebitis
1. Infection | 2. Peripheral vein thrombophlebitis or infiltration
37
List two kinds of monitoring related to fluid and general nutritional status
1. Fluid status | 2. General Nutritional status
38
List two kinds of monitoring related to salts
1. Electrolytes | 2. Acid-base
39
List three kinds of monitoring related to fats and sugars
1. Hyperglycemia 2. Hypoglycemia 3. Triglyceride
40
List one kind of monitoring related to liver
Hepatic function tests
41
List one kind of monitoring related to readiness to switch
Montior for patient readiness for oral or EN support
42
List three monitoring parameters for infection in patients receiving PN
1. Temperature 2. WBC 3. Intravenous access site
43
List three symptoms of peripheral vein thrombophlebitis
1. Pain 2. Erythema 3. Tenderness
44
What is a symptom of infiltration that is different from peripheral vein thrombophlebitis
Palpable cord at the site of the peripheral vein
45
How to treat peripheral vein thrombophlebitis or infiltration?
Remove catheter
46
List five monitoring parameters for fluid status in patients receiving PN
1. Weight 2. Edema 3. Vital signs 4. Input and output 5. Temperature
47
What lab value is useful for monitoring the effects of long-term nutrition support? What patients is not used in? Why is it superior to a related lab value?
Prealbumin (not critically ill) because it has a shorter half-life than albumin
48
What are the three ranges for prealbumin? (Normal, moderate malnutrition, severe malnutrition)
1. Normal rangge: 16-40 mg/dL 2. Moderate malnutrition, 11-16 mg/dL 3. Severe malnutrition, less than 11 mg/dL
49
How to use prealbumin to track progress towards goal in malnourished patients?
Goal for malnourished patients is an increase of at least 3-5 mg/dL until within normal range.
50
Why is serum albumin a poor predictor of nutritional status?
Serum albumin (normal 3.5-5 g/dL) is a poor predicator of nutritionl status because it has a long half-life, and concentrations fluctuate during illness.
51
What is a common blood glucose goal in patients receiving PN?
140-180 mg/dL
52
____ (initially ___ to ___ units per g of dextrose) can be added to the PN for patients using a consistent dosage to control hyperglycemia
1. Regular insulin | 2. 0.05-0.2 units per g of dextrose
53
Abrupt discontinuation of PN is usually tolerated in _____ patients
Nondiabetic
54
What can happen in diabetic patients who have PN abruptly discontinued?
Rebound hypoglycemia
55
List two strategies to prevent rebound hypoglycemia in diabetic patients receiving PN?
1. If PN is discontinued abruptly, rebound hypoglycemia can be avoided by administering 5% or 10% dextrose. 2. Or, you can gradually taper off of PN over 1-2 hours. 3. Check BG 30 minutes to 1 hour after discontinuing PN.
56
Monitor for electrolyte and acid-base imbalances. The ____ and ___ salts can be adjusted on the basis of acid-base status of the patient.
1. chloride | 2. acetate salts
57
For metabolic alkalosis, Na2+ and K+ can be administered as _____ salts
Chloride
58
For metabolic acidosis, Na+ and K+ can be administered as the _____ salts. Why?
1. Acetate | 2. Acetate is converted to bicarbonate
59
What should you adjust in patients receiving PN with respiratory acid-base disorders?
1. Correct the underlying cause (e.g. overfeeding) | 2. Adjust the ventilator settings as needed
60
Withhold lipids in patients with a triglyceride concentration greater than _____
400 mg/dL
61
When calculating lipid requirements for PN, account for any _____ mixed in a lipid emulsion. Give two examples
1. Drugs 2. Propofol 3. Clevidipine
62
List two categories of patients that may transition from PN to EN or oral
1. Well-nourished, healthy patients | 2. Older adult, debilitated, or malnourished patients
63
How to transition from PN to EN or oral in a well-nourished, healthy patient?
1. Well-nourished, healthy patients can change immediately from PN to oral or EN
64
How to transition from PN to EN or oral in an older adult, debilitated, or malnourished patient?
1. Older adult, debilitated or malnourished patients may need a transition period in which oral or EN feedings are gradually increased, coinciding with a reduction in PN.

BCPS Exam (34 decks)

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